From the Guidelines
Hyperhidrosis treatment should prioritize avoiding extreme temperatures and outdoor activities during the hottest periods of the day, as well as wearing adequate clothing and using cooling devices like air conditioning or fans to help regulate body temperature. When considering treatment options for hyperhidrosis, it's essential to note that the effects of local and systemic therapy on sweat glands are not well understood, as mentioned in a study published in the British Journal of Dermatology in 2019 1.
Key Recommendations
- Avoiding extreme temperatures and outdoor activities during the hottest periods of the day
- Wearing adequate clothing to help regulate body temperature
- Using cooling devices like air conditioning or fans
- Considering oral retinoids in cases with severe thermoregulation issues, as suggested by the same study 1 Some patients may also benefit from regular topical skincare, although the level of evidence for this recommendation is limited (LoE 4, GoR D) 1.
Additional Considerations
- Topical therapy may help reduce hyperkeratotic plugging of sweat glands
- Systemic retinoid therapy has shown positive effects in a case report, but more research is needed to confirm its efficacy It's crucial to weigh the potential benefits and limitations of each treatment option, considering the level of evidence and grade of recommendation, to provide the best possible care for patients with hyperhidrosis.
From the Research
Definition and Prevalence of Hyperhidrosis
- Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions 2.
- Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences 2.
Treatment Options for Hyperhidrosis
- Multiple therapies are available for the treatment of hyperhidrosis, including topical medications, iontophoresis, botulinum toxin injections, systemic medications, and surgery 2, 3, 4.
- Topical aluminum chloride solution is the initial treatment in most cases of primary focal hyperhidrosis 4.
- Botulinum toxin injection is considered first- or second-line treatment for axillary, palmar, plantar, or craniofacial hyperhidrosis 4.
- Iontophoresis is considered a primary remedy for palmar and plantar hyperhidrosis 3.
- Oral anticholinergics are useful adjuncts in severe cases of hyperhidrosis when other treatments fail 4.
Specific Treatment Options for Different Types of Hyperhidrosis
- For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and endoscopic thoracic sympathectomy (ETS) as fifth-line treatment 2.
- For palmar and plantar hyperhidrosis, a trial of oral medications is considered second-line therapy, iontophoresis is considered third-line therapy, and botulinum toxin injections are considered fourth-line treatment 2.
- For craniofacial hyperhidrosis, oral medications are considered first-line therapy, and topical medications or botulinum toxin injections may be useful in some cases 2.
Emerging Treatment Options
- Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating 3.
- Local microwave therapy is a newer treatment option for axillary hyperhidrosis 4.
- Botulinum toxin A is a safe and effective treatment for hyperhidrosis, and it has been shown to improve the quality of life in affected patients 5.
- Topical glycopyrrolate is a convenient method of treatment for moderate to severe symptoms of gustatory hyperhidrosis 6.